Improving hand hygiene in hospitals: A comparative study using body-worn cameras and direct observation

Hand hygiene (HH) prevents infections, but traditional monitoring is limited by office hours and the Hawthorne effect. We used body-worn cameras in ICU to compare video with direct observation.

After ethics approval, staff wore a GoPro™ on the upper abdomen during patient care. A trained observer simultaneously documented opportunities and performance. A blinded researcher analyzed the video. Both methods were compared on opportunities, compliance, performance, and duration.

Seventeen paired video and observer data sets captured 166 HH opportunities and 147 events. Of these, 118/147 (80%) were in response to a HH opportunity and 29/147 not (20%). Including HH performance-related to events, overall HH compliance was 71%. Both methods identified 80% of opportunities. Video detected 11.5% of missed opportunities, while the observer identified 8.5% missed by video. Mean duration was comparable (11.3±9.2 sec vs. 12.0±9.8 sec, p=0.55).

Body-worn cameras effectively identified HH opportunities, performance, and duration, capturing events missed by observers ~20% of the time. However, video analysis had flaws, revealing missed events upon review. Observer data, long considered the gold-standard, showed only 80% accuracy.

Body-worn cameras are a feasible tool for HH monitoring, but are labor-intensive. Automating video analysis could enhance feasibility for routine use.